For most people, low bone density is the cause of fragile bones, fractures, and breaks. But most people with diabetes have normal or even high bone density, and yet they break bones at three times the normal rate. A team of experts at the Bone Biomechanics Lab set out to determine what could be causing dense bones to break so easily.

The answer, of course, is a complicated one, but it seems to boil down to two variables: sugar levels and the bone’s ability to heal itself. We’ll dig deeper into these factors below.

Sugar Levels

While many people with diabetes keep good control of their blood sugar most of the time, there are still those who have a difficult time controlling their blood glucose levels some or all of the time. This leads to increased sugar levels in various parts of the body, including in the bone.

Bones naturally acquire microfractures from the regular everyday stress placed on them, and they “remodel” themselves using new proteins made up of amino acids. However, the amino acids react with sugars in the body in a process called non-enzymatic glycation. This process is similar to how a cut-up apple browns when it is exposed to the air, but in the case of the human body, it causes the development of tiny bridges called crosslinks, which stiffen the bone.

A stiff or rigid bone sounds like a positive development, but in actuality, bones need to have some flexibility and give to them in order to absorb impacts without breaking. So a person with more crosslinks and stiffer bones is more likely to break that bone if they fall or find themselves in some other type of situation involving a significant impact.

Of course, everyone has some sugar in their body, and everyone gets some crosslinks in their bones. However, the high amount of sugar in the bodies of many people with diabetes, therefore, leads to a higher number of crosslinks and more brittle bones.

Bone healing

As mentioned above, bones are meant to heal themselves, and they do so on a daily basis. They are functioning organs which have active roles in keeping our bodies healthy and strong. However, in people with diabetes, the bone’s ability to remodel itself is impaired.

In the normal human body, crosslinks are broken down and disposed of over time, but this healing process is slower in a person with diabetes. This further contributes to the buildup of crosslinks and the brittle nature of the bones.

So there you have it. High sugar levels lead to crosslinks in the bone, which causes stiffness. Then an inability to properly flush out crosslinks makes the problem worse. And rigid bones are more likely to break than to flex under pressure. There’s still more to be learned, but this is a huge window into what’s going on.

As diabetes becomes more prevalent in the United States, skeletal fragility has become something of an epidemic. However, it’s not a well-known issue, making it all the more dangerous for people who are at high risk of breaking bones. Please share to let others know what they can do to help keep their bones healthy, strong, and whole!

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Elizabeth Nelson is a wordsmith, an alumna of Aquinas College in Grand Rapids, a four-leaf-clover finder, and a grammar connoisseur. She has lived in west Michigan since age four but loves to travel to new (and old) places. In her free time, she. . . wait, what’s free time?